Medicaid Prescription Drug Policies and Medication Access and Continuity: Findings From Ten States

West, Joyce C.; Wilk, Joshua E.; Rae, Donald S.; Muszynski, Irvin S.; Stipec, Maritza Rubio; Alter, Carol L.; Sanders, Karen; Crystal, Stephen; Regier, Darrel A.

doi:10.1176/ps.2009.60.5.601

Cited by 32 publications

(17 citation statements)

References 36 publications

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“…54 Such changes may have increased drug substitutions and/or wait times for medications. 55 Our study found no association between Massachusetts health reform and decreased access to primary care for privately or publicly insured CSHCN, despite well-publicized concerns about primary care shortages. 16,21 This finding may be because, although some CSHCN see family practitioners, the majority (78%) of CSHCN receive care from pediatricians and may be protected from delays observed in adult primary care.…”

Section: Discussioncontrasting

confidence: 74%

Massachusetts Health Reform and Access for Children With Special Health Care Needs

Smith

Chien

2014

Pediatrics

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BACKGROUND AND OBJECTIVES: Children with special health care needs (CSHCN) face unique challenges in accessing affordable health care. Massachusetts implemented major health reform in 2006; little is known about the impact of this state’s health reform on uninsurance, access to care, and financial protection for privately and publicly insured CSHCN. METHODS: We used a difference-in-differences (DD) approach to compare uninsurance, access to primary and specialty care, and financial protection in Massachusetts versus other states and Washington, DC before and after Massachusetts health reform. Parent-reported data were used from the 2005–2006 and 2009–2010 National Survey of Children with Special Health Care Needs and adjusted for age, gender, race/ethnicity, non-English language at home, and functional difficulties. RESULTS: Postreform, living in Massachusetts was not associated with significant decreases in uninsurance or increases in access to primary care for CSHCN. For privately insured CSHCN, Massachusetts was associated with increased access to specialists (DD = 6.0%; P ≤ .001) postreform. For publicly insured CSHCN, however, there was a significant decrease in access to prescription medications (DD = –7.2%; P = .003) postreform. Living in Massachusetts postreform was not associated with significant changes in financial protection compared with privately or publicly insured CSHCN in other states. CONCLUSIONS: Massachusetts health reform likely improved access to specialists for privately insured CSHCN but did not decrease instances of uninsurance, increase access to primary care, or improve financial protection for CSHCN in general. Comparable provisions within the Affordable Care Act may produce similarly modest outcomes for CSHCN.

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Section: Discussioncontrasting

confidence: 74%

Massachusetts Health Reform and Access for Children With Special Health Care Needs

Smith

Chien

2014

Pediatrics

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“…In fact, very few studies that assessed out-comes of such programs have been published. One study of such a program demonstrated that use of nonpreferred antipsychotics was reduced by up to 13.9% (9) but was associated with an unintended increase in antipsychotic treatment discontinuities among Medicaid recipients and did not change total pharmacy reimbursements (10,11). Prior authorization with step therapy—the required use of one medication before trying another—achieved the intended goal of reducing use of second-generation agents but was associated with increased outpatient treatment (12).…”

Section: Strategies To Improve Quality Of Prescribingmentioning

confidence: 99%

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

Brunette

Nesnera²,

Swain³

et al. 2011

Psychiatric Services

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State mental health authorities can use public-academic partnerships to create professional roles in which leaders can track trends, identify problems, and carry out quality improvement projects to address key issues. Leaders with positions in both academic institutions and state mental health authorities ensure access to resources, technical expertise, and key relationships to improve quality. The authors describe a public-academic partnership in New Hampshire and a quality improvement program it carried out. The program encourages providers at community mental health centers to adopt prescribing practices that limit the cardiometabolic side effects of antipsychotic medicines.

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“…Given the large number of children with unknown race/ethnicity, a problem common to Medicaid claims data studies, 19,20 we imputed race data for our final models by using SAS PROCMI and all available independent and dependent variables. To verify our analyses, we compared results to regression models by using race data without imputation and found similar results.…”

Section: Discussionmentioning

confidence: 99%

Behavioral Health Services Following Implementation of Screening in Massachusetts Medicaid Children

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Behavioral health (BH) screening is known to increase identification of children with BH issues, but in small-scale studies, rates of follow-up after screening have been reported to be low. WHAT THIS STUDY ADDS:This study examines the relationship between BH screening and the receipt of BH services in Massachusetts Medicaid children. Nearly 60% of children identified with BH problems received BH services, but only 30% of newly identified children received BH services. abstract OBJECTIVES: To determine the relationship of child behavioral health (BH) screening results to receipt of BH services in Massachusetts Medicaid (MassHealth) children. METHODS:After a court decision, Massachusetts primary care providers were mandated to conduct BH screening at well-child visits and use a Current Procedural Terminology code along with a modifier indicating whether a BH need was identified. Using MassHealth claims data, a cohort of continuously enrolled (July 2007-June 2010) children was constructed. The salient visit (first use of the modifier, screening code, or claim in fiscal year 2009) was considered a reference point to examine BH history and postscreening BH services. Bivariate and multivariate logistic regression analyses were performed to determine predictors of postscreening BH services. RESULTS:Of 261 160 children in the cohort, 45% (118 464) were screened and 37% had modifiers. Fifty-seven percent of children screening positive received postscreening BH services compared with 22% of children screening negative. However, only 30% of newly identified children received BH services. The strongest predictors of postscreening BH services for children without a BH history were being in foster care (odds ratio, 10.38; 95% confidence interval, 9.22-11.68) and having a positive modifier (odds ratio, 3.79; 95% confidence interval, 3.53-4.06).CONCLUSIONS: Previous BH history, a positive modifier, and foster care predicted postscreening BH services. Only one-third of newly identified children received services. Thus although screening is associated with an increase in BH recognition, it may be insufficient to improve care. Additional strategies may be needed to enhance engagement in BH services. Pediatrics 2014;134:737-746

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Medicaid Prescription Drug Policies and Medication Access and Continuity: Findings From Ten States

Abstract: These associations indicate that more effective Medicaid prescription drug management and financing practices are needed to promote medication continuity and improve treatment outcomes.

Cited by 32 publications

References 36 publications

Massachusetts Health Reform and Access for Children With Special Health Care Needs

Massachusetts Health Reform and Access for Children With Special Health Care Needs

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

Behavioral Health Services Following Implementation of Screening in Massachusetts Medicaid Children

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